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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Permit Fees: ; to <br /> d <br /> DwellinglPrincipal Building-Sin le Family $300 Addition to DwellinglPrincipal Building-Sin le Family $200 � O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &11 $200 Addition to Accessory Structure-Commercial Cl &II $200 X <br /> Deck/Stairs/Patios59.692(l <br /> $l25 Gazebo(WI Stat vp $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> o <br /> *NOTE:After-the-Fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, retaining walls. <br /> b <br /> Applicant Complete All Sections Below This Line �. <br /> ./ z <br /> 0 <br /> Applicant's Name: Ly 00 o Ct ea Z'y a t Y.cn Q,'&q-�- <br /> Applicant's Mailing Address: Vt{ 4L e ?C+ {nm hnd <br /> City State Zip 4 <br /> 4 <br /> cp ( `C�`��i <br /> Applicant's Telephone Number: ��- grfbI z_ c y <br /> Applicant's Email: 8Q <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter MPhoneOq PEmail 00 <br /> 0 <br /> Legal Description: <br /> .51 g 1 -0 U <br /> Lot#:_ CSM Vol. 9- OR 1 <br /> N <br /> A 1 <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits):_ O 1 b t w � <br /> Property Site Address#: Z / I 1 <br /> Road Name: ( � 161,4 19 (,4k - kis K City: N <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Reca� r t n <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> 64 Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure C <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition S M <br /> D <br /> p / 1 � z <br /> Proposed Structure/Addition Use: A r�e `t- 11 1. <br /> ( ome/Cabin;Commercial Business;B room:Deck:etc. W u u 11 <br /> " N <br /> Building Contractor: O o <br /> q A C <br /> Anticipated Start Date: d `" m <br /> Page 1 of 4 o U <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> 9 <br /> z <br /> m <br /> m <br />